According to the adjunct professor of health policy at the Harvard School of Public Health, disrespect is the reason why so many patients leave the E.R. feeling belittled or ignored. It’s why medical workers feel so “demoralized.” And it’s why—despite attempts at change in the last decade—we still see medical errors that cause needless suffering and even cost lives.

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In a pair of papers published in July in the journal Academic Medicine, Leape and his co-authors outlined six categories of disrespect, ranging from the obvious to the subtle. On one end lies the overtly disruptive behavior: the angry outbursts, swearing, and bullying. More common is humiliating and demeaning treatment (by teachers to medical students, surgeons to nurses, physicians to patients). But there are also behaviors and

attitudes that we might not think of as “disrespect”: passive-aggression (harshly criticizing colleagues to psychologically harm them), passive disrespect born of apathy and burnout (“I don’t have to wash my hands”), and dismissive treatment of patients (refusing to return their calls or answer their questions).

The final category may be the most crucial for changing hospital cultures—and the most difficult to combat. Leape and his co-authors refer to this as the “systemic” disrespect that’s baked into the profession. ...

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“Doctors have always felt entitled—we teach them that in medical school,” Leape said in Washington. “That’s the challenge. How do you teach them to know a lot and really be outstanding at what they do and not feel that they need to be treated specially?”